RT Book, Section
A1 Nolin, Thomas D.
A1 Perazella, Mark A.
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182441904
T1 Drug-Induced Kidney Disease
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182441904
RD 2024/04/19
AB KEY  CONCEPTSThe  initial  diagnosis  of  drug-induced  kidney  disease  (DIKD)  typically  involves  detection  of  elevated  serum  creatinine  (Scr)  and  blood  urea  nitrogen,  for  which  there  is  a  temporal  relationship  between  the  toxicity  and  use  of  a  potentially  nephrotoxic  drug.DIKD  is  best  prevented  by  avoiding  the  use  of  potentially  nephrotoxic  agents  for  patients  at  increased  risk  for  toxicity.  However,  when  exposure  to  these  drugs  cannot  be  avoided,  recognition  of  risk  factors  and  specific  techniques,  such  as  hydration,  may  be  used  to  reduce  potential  nephrotoxicity.Acute  tubular  injury/necrosis  (ATN)  is  the  most  common  presentation  of  DIKD  in  hospitalized  patients.  The  primary  agents  implicated  are  aminoglycosides,  radiocontrast  media,  cisplatin,  amphotericin  B,  and  osmotically  active  agents.Angiotensin-converting  enzyme  inhibitors  (ACEIs)  and  nonsteroidal  anti-inflammatory  drugs  (NSAIDs)  are  associated  with  hemodynamically  mediated  kidney  injury,  the  pathogenesis  of  which  is  a  decrease  in  glomerular  capillary  hydrostatic  pressure.Acute  allergic  interstitial  nephritis  (AIN)  is  observed  in  up  to  27%  of  kidney  biopsies  performed  for  hospitalized  patients  with  unexplained  acute  kidney  injury  (AKI).  Clinical  manifestations  of  AIN  typically  (but  not  always)  present  approximately  14  days  after  initiation  of  therapy  and  may  include  fever,  maculopapular  rash,  eosinophilia,  arthralgia,  as  well  as  pyuria,  hematuria,  proteinuria,  and  oliguria.